Topic Contents

Social Anxiety Disorder

Topic Overview

What is social anxiety disorder?

People with
social anxiety disorder (or social phobia) are extremely anxious about what
they will say or do in front of other people. This includes public speaking and
day-to-day social situations. But it is more than just being shy or nervous
before public speaking. The fear can begin weeks or months before an event. It
can cause a fast heartbeat and make it hard to focus.

Some people
fear only one or a few types of social situations. For other people, many
situations cause stress. This problem affects your daily life. You may be so
stressed or afraid that you avoid public situations, including missing work and
school.

What causes social anxiety disorder?

Doctors don't
know what causes social anxiety disorder. They think it may run in families. But they are not sure if it's because of
genetics or a response to a traumatic situation.

What are the symptoms?

Social anxiety disorder
causes both emotional and physical symptoms.

It can make you nervous, sad, or easily upset
before or during a social event. You may worry a lot or be afraid that
something bad will happen.

The anxiety can cause you to blush,
sweat, and feel shaky. Your heart may beat faster than normal, and you may have
a hard time focusing.

How is social anxiety disorder diagnosed?

To
diagnose social anxiety disorder, your doctor will examine you and ask about
your symptoms. He or she may ask other questions to see how you are doing
emotionally. This is called a mental health assessment.

Your
doctor may also do blood or urine tests to rule out other conditions, such as
thyroid problems that can cause similar symptoms.

How is it treated?

Treatment of social anxiety
disorder includes counseling, such as cognitive-behavioral therapy, and sometimes medicine, such as antidepressants.
Whether you need medicine depends on how much the problem affects your daily
life. If you already feel anxious around other people, it may be hard to ask
for help. But treatment for social anxiety disorder works for many people.

Some people with social anxiety disorder turn to alcohol or drugs
to help them relax. This can lead to
addiction problems. They may also have
depression. It is important to treat these issues
too.

Symptoms

Social anxiety disorder causes unreasonable,
debilitating fear of being judged or publicly humiliated. You may avoid or
severely limit encounters with other people-which can keep you from daily
activities. You may develop physical symptoms such as a rapid heartbeat,
shortness of breath, or tightness in your chest when faced with a feared social
situation.

When you have social anxiety disorder, common social
situations-such as eating in public, writing in front of other people, using a
public restroom, or speaking in front of others-can cause overwhelming fear and
anxiety.

You may be more afraid of people noticing your
anxiety than of the actual feared situation. A vicious
cycle can emerge of avoiding or worrying about the social event (such as
speaking in public) because you are afraid others will see you as weak,
anxious, or foolish-this, in turn, leads to more anxiety. This may lead to
avoiding or limiting contact with other people.

Symptoms of social
anxiety disorder may differ in adults and children.
Adults and teenagers with social anxiety disorder usually
recognize their fears of being publicly humiliated are unreasonable or
excessive. But children who have this disorder may not.

People with social anxiety disorder often underachieve at work or
at school to avoid the attention of a promotion or to avoid being forced to
participate in a group. They tend to have few friendships and have trouble
dating or developing relationships. In prolonged or severe cases, many people
develop other psychological conditions (such as
depression or
substance abuse).

Social anxiety disorder
is among several types of
phobias that many people experience, such as
agoraphobia or
a specific phobia (fearing an object, like a spider, or
a frightening situation, such as being stuck in an elevator).

Exams and Tests

Social anxiety disorder is diagnosed based on your
medical history,
physical exam, and sometimes a
mental health assessment , which is an evaluation of
psychological symptoms. You may be asked to answer questions about your anxiety and what makes it better or worse.

Blood or urine tests may also be done to
rule out
other medical conditions that can cause similar symptoms (such as
hyperthyroidism).

Unfortunately, many
people don't seek treatment for anxiety disorders. You may not seek treatment
because you think the symptoms are not bad enough or that you can work things
out on your own. But getting treatment is important.

If you need
help deciding whether to see your doctor, see
some reasons why people don't get help and read about how to overcome them.

Initial and ongoing treatment

Initial treatment
of
social anxiety disorder is based on how bad your emotional and physical symptoms are and how able you are to function in daily
activities. People who have social anxiety disorder often have
depression also. They may also have alcohol or
substance abuse problems. Your doctor may ask you certain questions to see whether you might be drinking too
much or abusing drugs.

Social anxiety disorder often goes
undetected for years before treatment is sought. By that time, you may have
developed behaviors that accommodate the fears. These habits or behaviors must
be overcome to successfully manage social anxiety disorder.

First, your doctor must determine whether you are generally
anxious about all social encounters or whether a specific situation triggers
anxiety.

A
particular type of psychological counseling, cognitive-behavioral therapy (CBT), has been shown to help treat social anxiety
disorder. Often your doctor will recommend counseling first and then add medicine if needed. But your treatment plan will depend on what you and your doctor decide is best for you.

Counseling

It is possible to
overcome the fears linked with social anxiety disorder. Working through
fears with a specific type of therapy-cognitive-behavioral therapy that
includes exposure therapy-may be the best approach for treating your anxiety.
It is important to continue professional counseling even if you are taking
medicines to reduce anxiety.

Types of counseling most often used to treat social anxiety
disorder include:

Cognitive-behavioral therapy, which helps you identify anxieties and the situations that
provoke the anxiety. At first you may feel uncomfortable while addressing the
feared situations, but it is an important part of your recovery. Several types
of cognitive-behavioral therapy are used to treat social anxiety disorder,
including:

Exposure therapy .
You will be guided by a professional counselor to imagine you are facing the
feared situation until you no longer fear it, such as eating in public. Next,
you may go with your counselor to a public place and eat until, eventually, you
can eat by yourself in public without fear.

Social skills training.
This therapy helps you develop the skills you need in social situations through
rehearsing and role-playing. Your anxiety is reduced as you become more
comfortable with and prepared for the feared social
situations.

Cognitive restructuring. This therapy helps you learn
to identify and improve fearful thinking to help you better handle social
situations.

Medicines

Monoamine oxidase inhibitors (MAOIs), to relieve depression and anxiety. MAOIs have
potentially serious side effects when they are taken with certain foods (such
as some cheeses and red wine).

Benzodiazepines, to relieve anxiety.
They are fast-acting. But they may be habit-forming and are not generally
used in those who have substance abuse problems.

Beta-blockers , to
reduce anxiety. Beta-blockers are sometimes used to treat physical symptoms of
anxiety (such as
tremors or rapid heart rate).

Ongoing treatment of social anxiety disorder usually
includes continuing psychological
counseling and regular checkups to monitor any
medicines you may be taking. If professional counseling alone has not reduced
your anxiety symptoms, medicines may be added to your treatment.

If your anxiety is triggered by many social situations (generalized), you
may need continuous and prolonged treatment with a combination of counseling
and medicines. During this time, your doctor will need to
monitor your medicines. If one medicine doesn't work for you, you and your doctor may decide you should try another.

Treatment if the condition gets worse

With
social anxiety disorder, it is possible to progress
from debilitating fear of one social situation to having anxiety about all
social encounters (generalized). If this occurs, additional treatment is needed
that usually includes adding medicines and increasing the amount of
professional
counseling you receive.

You may also feel
more anxious when you start professional counseling. This is because you are
thinking about the situations that cause you fear and anxiety. After the
situations have been identified, the fears can be addressed through
counseling-especially
cognitive-behavioral therapy which includes
exposure therapy -gradually exposing you to your
fear.

If you are taking medicines to treat social anxiety
disorder, you will need regular checkups to monitor the medicines and their
potential side effects. The medicines may cause bothersome side effects that
may make your anxiety worse at first. These side effects may get better over
time. But if they do not, you may need to take a different medicine.

If social anxiety disorder is left untreated or improperly treated, it
can cause debilitating distress that interferes with daily activities. Physical
symptoms such as rapid heart rate, blushing, shortness of breath, and dizziness
can occur and need to be assessed.

Home Treatment

While counseling and medicines are
the most effective treatments for
social anxiety disorder, you may wish to
reduce your anxiety level at home by practicing a
healthy lifestyle.

Get regular exercise . Start slowly so
that you don't overdo it. Build up your exercise program bit by bit, and aim
for at least 2½ hours a week of
moderate exercise. It's fine
to be active in blocks of 10 minutes or more throughout your day and
week.footnote 1

Get enough sleep by
going to bed at nearly the same time every night. Also, keep your room quiet
and dark. This may reduce distractions and may help you get a good night's
rest.

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